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Occipital neuralgia / MS
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Occipital neuralgia / MS

Recently I had a really hard time recovering after a respiratory virus (Dec) among other symptoms, afterwards I had pain when I moved my eyes that was dx as optical neuritis.  After reading about it I thought that I had a attack of MS.  

I went to the Nero last week and he has stated that I do not have MS.   I supposed because I only have 1 very small enhancing  lesion behind my "Right" eyeball.  Interestingly my Optical Neuritis symptoms (pain when I moved it) were in my "left"eye???   I didn't go to the Dr. for two months after the pain started.

The Neuro stated that he didn't know what was causing my other symptoms.   My VEP and AEPs were normal.   He didn't do a LP.  I find myself wondering if he would have felt differently if he had.

Anyway, now I have this terrible throbbing pain (makes me dizzy and nauseous) at the base of my head and migraine type pain behind the left eye again (as if it ever went away) . The pain when I move it is still there and worse at the end of the day and when I close my eyes.   I also have a neuralgia like pain that shoots through my temple.   Also there was no problem with my C1-C2 area of my MRI that would suggest an injury to cause the pain.

It also feels better if I massage the area at the base of my skull, but hurts worse after I stop.

I have read the occipital neuralgia should be considered an exacerbation in  MS.   I don't know what to do?  I don't want to call the DR and be a pain in the "you know what".  But it's been happening for about two days now and I just had a c-spine MRI 2 1/2 weeks ago.     What should I do?   I don't want him to think I am crazy and I also don't want to waste the Dr. time or resources.

I am so extremely frustrated right now.
Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Optic neuritis is an inflammation of the optic nerve, the bundle of fibers in your eye that transmits information to your brain. Symptoms include pain in the eye and vision loss. Color vision loss can also occur. Optic neuritis may be viral, may have no known cause, or may be a manifestation of multiple sclerosis. Most people who have one episode will recover their vision. While eye exam may be entirely normal, another test, called the visual evoked potential, which gives information as to how long electricity takes to move along the nerve, will be abnormal and will point to the diagnosis. I understand that you have already had this test.

There are multiple other causes of transient visual obscuration, one of which is transient ischemic attack, or TIA, whereby a small artery to the retina gets clogged with clot. This is a sign of increased risk of stroke. This is more likely in people older than 50 with diabetes, high cholesterol, high blood pressure, or other factors that increase risk of stroke. In patients older than the age of 55, a type of inflammation of one artery in the head called the temporal artery, a condition called temporal arteritis needs to be ruled out.

Pain at the base of the head where the neck meets and an inch over is likely from a nerve called the greater occipital nerve. It can cause a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It may even radiate to the forehead. It is usually a one sided pain but can be on both sides of the head. It is commonly experienced by patients after whiplash injury, or a fall on the back of the head, or other closed head injuries. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

I suggest that you do update your physician. He/she may wish to see you and discuss further workup and management.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

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